Embodiments described herein generally relate to an airway assembly and methods of using an airway assembly. More specifically, embodiments described herein relate to devices for endotracheal intubation and methods of performing endotracheal intubation. Tracheal intubation is a common and routine procedure for restoring or for maintaining the air passageway to ventilate the lungs by allowing for externally applied or artificial respiration when the patient is unable to breath. Endotracheal intubation is a procedure by which an endotracheal tube is inserted through the mouth into the trachea. Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure. Often, endotracheal intubation is used when patients are critically ill and cannot maintain adequate respiratory function to meet their needs.
Conventional endotracheal tubes consist generally of a semi-rigid flexible plastic tube having a beveled distal end, a ventilator connector at a proximal end for connecting an external ventilator to the endotracheal tube, a dilatable balloon positioned proximate the distal end of the tube and, coupled to an outer wall surface of the tube, an inflation tube or lumen associated with the tube wall that communicates air to the balloon to inflate the balloon and seat the balloon, and, hence, the tube, within the trachea and seal the trachea to prevent backflow of air.
Usually, an endotracheal tube is inserted using a laryngoscope that permits visualization of the vocal cords and the upper portion of the trachea and retracts the tongue during intubation. Proper intubation is critical in order to ventilate the lungs. If the tube is inadvertently placed in the esophagus, adequate lung ventilation will not occur, with possible concomitant neural injury, cardiac arrest or death. Aspiration of stomach contents can result in pneumonia and acute respiratory distress syndrome. Placement of the tube too deep can result in only one lung being ventilated and can result in a pneumothorax as well as inadequate ventilation. During endotracheal tube placement, damage can occur to the teeth, to the soft tissues in the back of the throat, as well as to the vocal cords.
Assuming that an endotracheal tube is placed properly and is secured within the trachea by an inflated balloon, the endotracheal tube provides a good air passageway to ventilate the lungs, however, having an endotracheal tube residing within the trachea implies several changes to the patient's airways. An important change when a patient is intubated is that the airway passages loses sterility and becomes colonized within a few hours of starting mechanical ventilation with a risk of ventilator associated pneumonia—around 8% to 28% of patients admitted in the intensive care unit. The risk for developing pneumonia has been clinically demonstrated to be associated with the current endotracheal tubes. Pneumonia is often the result of aspiration during intubation secondary to the large size of the endotracheal tubes being introduced through the narrow vocal cord space, contaminated secretions pooling above the endotracheal tube cuff or secretions leaking around the cuff. Leakage around an endotracheal cuff is commonly associated with a decreased pressure inside the cuff which occurs a few hours post-inflation and the resultant formation of creases or channels in the partially deflated cuff that allow contaminated secretions to pass into the more distal bronchial passages. Finally, pneumonia may occur due to decreased clearance of mucus produced by the lungs. Decreased mucus clearance frequently occurs in patients requiring mechanical ventilation due to the position of the tube in the middle of the trachea such that distal secretions are not removed by patient coughing but are only removed by a suction catheter advanced into the distal bronchial passages through the endotracheal tube. There are other drawbacks presented by currently available endotracheal tubes, specially related to the pressure transmitted from the cuff to the tracheal mucosa. This has been associated with post-intubation tracheal narrowing or stenosis which is a very serious complication with devastating implications for patients and requiring a very complex surgical management that is performed in few specialized centers. Accordingly, it is desirable to improve endotracheal tubes.